Magnolia Gardens PCH, Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

MAGNOLIA GARDENS PCH, INC

Practice address

5348 Kelleys Creek Dr
Stone Mountain, GA 30088-3827

Phone

(770) 469-8925

Fax

(770) 469-8925

NPI assigned

Jul 31, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Teri D. Cargill

Title

Director

Phone

(678) 697-0575

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268352000000",
    "number": "1912138454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 684",
            "city": "LOVEJOY",
            "state": "GA",
            "postal_code": "302500684",
            "telephone_number": "770-469-8925",
            "fax_number": "770-469-8925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5348 KELLEYS CREEK DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300883827",
            "telephone_number": "770-469-8925",
            "fax_number": "770-469-8925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA GARDENS PCH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-31",
        "last_updated": "2010-03-12",
        "status": "A",
        "authorized_official_last_name": "CARGILL",
        "authorized_official_first_name": "TERI",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "678-697-0575",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256949895B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trecia Lyon
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• Quintina L Macauley, APRN-BC
• Traci Mackey
• Sonya Magar
• Jennifer Mai, OD
• Rodney Mallory
• Jessica Laine Malmad, M.D., M.P.H
• Getahun Mamo
• Casianne Abigail Manning

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.